Observation Of Clinical Curation Effects Of Pneumonia Caused By Congenital Heart Disease Complicated By Congestive Heart Failure Given Inhaled Sodium Nitroprusside

Objective: At present,the congenital malformation was the first deathcause of infants in our country,and the congenital heart disease was the chiefconstituent.It greatly impaired the growth and development of the infants.If betreatment not in time by operation,the infants would lose the best time point totreat because of the repeating respiratory infection,pulmonaryhypertention(PAH) or congestive heart failure.The pneumonia of the infantswith CHD complicated with congestive heart failure was the common criticaldisease of the PICU infants.It has been confirmed that PAH was one of thepathological mechanism of the pneumonia of the infants with CHDcomplicated with congestive heart failure.At present,there were no effectivedrugs to reduce the PAH clinically.Sodium nitroprusside was an often-usedvasodilator and carbon monoxide donor.The foreign scholars mostly usedanimal experiments to study inhalation of sodium nitroprusside.In thisstudy,40cases of pneumonia of the infants with CHD complicated withcongestive heart failure given inhaled sodium nitroprusside,and observedclinical signs,brachial blood pressure and the variation of CRP,then assessedthe curative effec of inhaling sodium nitroprusside and the effect to systemicarterial pressure.It could afford a new approach and theoretical basis forclinical application.Method:According to the diagnostic criteria used for children of theCHD,we selected80cases of pneumonia caused by CHD complicated withcongestive heart failure.All the cases diagnosed and received treatment in ourpediatric unite during March,2010and December2011.All the cases wereconfirmed through doing heart colour afer admission that having CHD andcomplicated with PAH: pulmonary arterial systolic pressure (PASP)> 30mmHg(4Kpa) or pulmonary artery mean pressure(PAMP)>20mmHg(2.67Kpa).All the cases received no special treatmentbefore admission.All the cases were randomly seperated into two groups,onegroup received routine treatment,the other group treated with inhaling sodiumnitroprusside and the routine treatment.There were no significant differencebetween the two groups at age,sexuality and the kind of the CHD.The routinetreatment concluded tranquilizing treatment,oxygen inhalation,improvingcirculation and so on.The inhalation of sodium nitroprusside compsed ofnormal saline(2ml) and sodium nitroprusside(5mg),and the inhalation weregiven two or three times a day.Recorded the respiratory,heartbeat,palpation ofthe liver and the time of index returen to normal by the same researcher andused the same stethoscope、stopwatch and ruler,from the first day to the lastday in hospital.Recorded the brachial blood pressure by the same researcherand used the same sphygmomanometer before and after inhaling sodiumnitroprusside.We took the mean arterial pressure (MAP) adding1/3pulsepressure to represent the brachial blood pressure.Took the tip’s blood of all thecases once a day afer admission, then tested and recorded the value of CRP at7:00-9:00in the morning.The result were analysed by SPSS13.0software.Result: The lasting time of respiratory rate and heartbeat at a rapid levelin the routine treated group were44.29±5.17h and50.00±6.96hrespectively.The lasting time of respiratory rate and heartbeat at a rapid levelin inhaling sodium nitroprusside group were24.56±5.14h and32.60±4.67hrespectively.The difference between the two groups had statistical significance（P<0.01）.The result suggested that inhaling sodium nitroprusside can reducethe respiratory rate and heartbeat.The lasting time of enlargement of paplationthe liver in routine treated group were44.78±7.54h,and in the haling sodiumnitroprusside group were40.21±7.56h.There were significant differencebetween the two groups（P<0.01）.The result suggested that inhaling sodiumnitroprusside could prompt the retraction of the larger liver.Before inhalingsodium nitroprusside,the average brachial artery blood of the40cases ininhaling sodium nitroprusside group were64.35±3.08mmHg, and after inhaling sodium nitroprusside for5minitues,the pressure were64.48±3.37mmHg.Stopped inhalation for5minitues,the pressure were64.55±3.97mmHg.There were no differences among those groups(P>0.05).The resultsuggested that inhaling sodium nitroprusside had no effect on mean systemicaterial pressure.The lasting time of CRP at a high level in the routine groupwere7.60±1.25day,and in the inhaling sodium nitroprusside group the lastingtime were7.44±1.21day.There were no significant difference between the twogroups.The result suggested that inhaling sodium nitroprusside had nosignificant effect on treatment of the process of pneumonia.Conclusion:1Inhalation of sodium nitroprusside could effectivelydecrease the respiratory rate of the infants of pneumonia caused by CHDcomplicated with congestive heart failure.2Inhalation of sodium nitroprussidecould effectively decrease the heartbeat of of the infants of pneumonia causedby CHD complicated with congestive heart failure.3Inhalation of sodiumnitroprusside could prompt the retraction of the larger liver of the infants ofpneumonia caused by CHD complicated with congestive heart failure.4Inhalation of sodium nitroprusside lowered pulmonary pressure and did noteffect mean systemic arterial pressure. The security was high.5Inhalation ofsodium nitroprusside had no significant effect on treatment of the process ofpneumonia.We could add inhalation of sodium nitroprusside to the routine treatmentsin the treatment strategies of the infants of pneumonia caused by CHDcomplicated with congestive heart failure.It could effectively alleviate thesymptoms of the CHD at early stage,and it were easy to operate and thesecurity was high.